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File with Exemption Application FORM <br /> Your County for Tax Exemption on Real and Personal Property by Qualifying Organizations 451 <br /> Assessor Read instructions on reverse side. <br /> Failure to properly complete or timely file this application will result in a denial of the exemption. <br /> Name of Organization County Name Tax Year <br /> Grand Island Area Habitat for Humanity Inc Hall 2017 <br /> Name of Owner of Property State Where Incorporated <br /> Grand Island Area Habitat for Humanity Inc Nebraska <br /> Street or Other Mailing Address of Applicant Total Actual Value of Real and Personal Property Parcel ID Number <br /> 502 W.2nd St. $20,000.00 400128322 <br /> City Stale Zip Code Contact Name Phone Number <br /> Grand Island NE 68801 Dana Jelinek 308-385-5510 <br /> Type of Ownership <br /> ❑Agricultural and Horticultural Society El Educational Organization 0 Religious Organization ®Charitable Organization 0 Cemetery Organization <br /> Name ec of Officers, Address,City,State,Zip Code <br /> Directors,rs,or Partners <br /> Julie Markvicka President 2140 N Park, Grand Island, NE 68803 <br /> Sara Seim V.P. 4044 Lambchop, Grand Island, NE 68803 <br /> Daniel Roth Treasurer 4153 Arizona Ave., Grand Island, NE 68803 <br /> Legal description of real property and general description of all depreciable tangible personal property.except licensed motor vehicles: <br /> Evans Add., Blk 4, Lot 4 <br /> rr <br /> =' 2 2 ?Qio <br /> Property described above is used in the following exempt category(please mark the applicable boxes): <br /> Agricultural and Horticultural Society ❑ Educational 0 Religious Charitable 0 Cemetery <br /> Give a detailed description of the use of the property: <br /> construction site for low-income housing \ <br /> All organizations,except for an Agricultural and Horticultural Sc ns. <br /> Is all of prop rty property used exclusively or described above? <br /> the 1 ` 0 YES tx NO as <br /> Is the property used for tinanaal gain or profit to either the owner or< e property? 0 YES ®NO <br /> Is a portion of the property used for the sale of alcoholic beverages? YES i•,NO <br /> If Yes,state the number of hours per week <br /> Is the property owned or used by an organization which discriminates olor, <br /> or national origin? nYES 11 NO <br /> Under penalties of law,I declare that I have examined m my knowledge and belief,it is correct and <br /> complete. Iso declare th m du authorized to sign thi. ...,n. <br /> sign e4im S.D . 1Lirzz//to <br /> here rized Signature Title Date <br /> Retain a copy for your records. <br /> For County Assessor's Recommendation <br /> ❑ Approval COMMENTS: /7--an a <br /> ❑ Approval of a Portion <br /> n� _ <br /> Denial Signatu =of o my Assessor Date 1~ <br /> For County Boa•• of Equalization Use Only <br /> I declare that to the best of my knowledge and belief,the determination made by the County Board of Equalization is correct pursuant to the <br /> laws of the Stale of Nebraska. <br /> O Approved COMMENTS: <br /> ❑ Approval of a Portion /- �j� ^7 <br /> •.%Denied -� °L' `„ °`21 <br /> ignature of unty Board rii6eer Date <br /> County Clerk:A legible copy of this form showing the final decision of the County Board of Equalization <br /> must be delivered electronically to the Nebraska Department of Revenue within seven days after the Board's decision. <br /> Nebraska Department of Revenue.Properly Assessment Division Authorized by Neb.Rev.Stet.§§77.202.01 and 77-202.04 <br /> 96135.1999 Rev.1-2014 supersedes 96.135-1999 Rev-7-2012 <br />